Foo David, Walker Bruce D, Kuchar Dennis L, Thorburn Charles W, Tay Andre, Hayward Christopher S, Macdonald Peter, Keogh Anne, Kotlyar Eugene, Spratt Philip, Jansz Paul
Heart Institute, Tan Tock Seng Hospital, Singapore.
Pacing Clin Electrophysiol. 2009 Jul;32(7):879-87. doi: 10.1111/j.1540-8159.2009.02403.x.
Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy-pacemaker (CRT-P) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown.
We reviewed case records and device logs of 15 patients with ICDs or CRT-P or CRT-D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated.
Right ventricular (RV) sensing decreased in the first 6 months post-LVAD. Mean R-wave amplitude preimplant was 10.9 +/- 5.25 mV compared with 7.2 +/- 3.4 mV during follow-up (P = 0.02). RV impedance also decreased from 642 +/- 240 ohms at baseline to 580 +/- 212 ohms at follow-up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 +/- 0.6 V at baseline to 1.4 +/- 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy.
LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.
非搏动性左心室辅助装置（LVAD）越来越多地用于治疗难治性心力衰竭。大多数此类患者已植入心脏装置，即可植入式心脏复律除颤器（ICD）、心脏再同步治疗起搏器（CRT-P）或心脏再同步治疗除颤器（CRT-D）。然而，此类患者中LVAD与心脏装置之间的潜在相互作用仍不清楚。
我们回顾了15例植入ICD或CRT-P或CRT-D装置，随后植入VentrAssist LVAD（澳大利亚查茨伍德的Ventracor有限公司）作为终末期治疗或心脏移植桥梁的患者的病例记录和装置日志。比较了LVAD植入前后起搏器和ICD导线参数。此外，还评估了室性快速心律失常事件日志和潜在电磁干扰报告。
LVAD植入后的前6个月，右心室（RV）感知功能下降。植入前平均R波振幅为10.9±5. mV，随访期间为7.2±3.4 mV（P = 0.02）。RV阻抗也从基线时的642±240欧姆降至随访时的580±212欧姆（P = 0.007）。LVAD植入后，RV刺激阈值从基线时的0.8±0.6 V显著增加到植入后的前6个月的1.4±1.0 V（P = 0.01）。在3例患者中观察到室性快速心律失常负担显著增加。1例患者的LVAD与除颤器之间出现电磁干扰，导致不适当的除颤治疗。
LVAD在导线参数改变、室性快速心律失常和电磁干扰方面对心脏装置有明确影响。
